Approved State Directed Payment Preprints

Behavioral Health Services (BHS) directed payment program, which is a uniform increase for Community Mental Health Centers and Local Behavioral Health Authorities, for the rating period covering September 1, 2025 through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty care services, for the rating period covering July 1,2024 through June 30, 2025, incorporated into capitation rates through a separate payment term of up to $1,243,115,716.

Comprehensive Hospital Increase Reimbursement Program (CHIRP), which has components consisting of both uniform increases and pay for performance for eligible hospitals, for the rating period covering September 1, 2025 through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Texas Incentive Physicians and Professional Services , which has components consisting of both uniform increases and pay for performance for eligible providers, for the rating period covering September 1, 2025 through August 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.

Minimum Fee Schedule established by the state for laboratory services provided by in-state acute care hospitals and critical access hospitals for the rating period covering July1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-basedrate adjustment.

Uniform percentage increase for services provided in inpatient hospitals for rating period covering July 1, 2025, through June 30, 2026, incorporated in the monthly capitation rates through a risk-based rate adjustment in the amount of $10,509,201.

Uniform percentage increase for physician services by physicians employed by or contracted with a private acute care type 2 hospital system with at least one level 2trauma center as of January 2022 located in Lord Fairfax Health District and Northwest Health Planning Region, for the rating period, July 1, 2025 through June 30, 2026,incorporated in to the capitation rates through a separate payment term of up to$5,098,995.

Uniform increase for inpatient and outpatient services rendered by non-state government owned acute care hospitals for the rating period covering July 1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $74,610,061.

Uniform percentage increase of 14.7% per claim for nursing facility services for the rating period covering July 1, 2024, through December 31, 2025, incorporated in the capitation rates through a risk-based rate adjustment in the amount of $14,961,418.

Uniform percentage increase for services provided in outpatient hospitals for rating period covering July 1, 2025, through June 30, 2026, incorporated in the monthly capitation rates through a risk-based rate adjustment in the amount of $10,205,734.